Saturday, 29 June 2013

Australia's ‘Dr Death’ Philip Nitschke (pictured left)
visited the UK this week and held a ‘workshop’ at Dragon Hall in London
providing instruction in how to commit suicide. About 150 people attended.

Not understandably the event evoked protests (see picture
below) and some
publicity.

In the week before Nitschke arrived I wrote to both the Home
Secretary Theresa May and the London Metropolitan Police Commissioner Sir
Bernard Hogan-Howe to advise them about his visit and to inform them that
I believed his workshop would be in breach of the Suicide Act 1961, under which
it is an offence to ‘encourage or assist’ suicide.

The Act does not require that a suicide is actually carried
out in order to for a prosecution to take place.

Quite possibly as a result Nitschke was briefly detained
at Gatwick airport but was eventually let in, presumably with the
permission of the Home Secretary.

The police did not attend the workshop but referred the
matter to the Crown Prosecution Service who decided that an investigation was
not necessary.

At his workshop last Tuesday Nitschke, who is on
public record as supporting suicide for ‘the depressed, the elderly
bereaved, (and) the troubled teen’, gave advice on the sourcing,
supply and use of barbiturates, nitrogen and other means that people could use
to kill themselves.

A 2010
report demonstrated that coroners were aware of 51 Australians who had
died from an overdose of Nembutal, a lethal barbiturate that Nitschke has
promoted since the late 1990’s as ‘a peaceful way to die’.

But this fact seems to leave Nistchke unperturbed.

When previously confronted with
the fact that 14 of the 51 were Australians in their 20’s and 30’s and only 11
of 38 investigated were known to have suffered chronic physical pain or a
terminal illness he responded that
‘there will be some
casualties’.

‘Max Dog Brewing’ is a business name for the company Northern
Analytics Pty Ltd which has ‘Philip Haig Nitschke’ as its sole
director.

Its website claims that nitrogen cylinders can be used for
home brewing (nitrogen produces the bubbles in stout) but Nitschke has admitted on
Australian national media that they can equally be used to commit suicide and there are much cheaper sources of the gas available for brewers.

I asked Nitschke on twitter this week how many nitrogen
cylinders he has so far sold to members of the British public but thus far he
has not responded.

However according to the Newstalk
ZB in New Zealand 'Max Dog Brewing' has already sent shipments to
both New Zealand and the UK.

So here we have a man who travels the world running
‘workshops’ in order to give information to people in order that they can
commit suicide.

He tells them where they can obtain barbiturate drugs and
sells kits for storage of the drugs and for measuring their concentration.

And he sells nitrogen cylinders via a company he has set up
for the purpose along with the necessary kit to deliver the gas.

Quite why this does not amount to ‘encouraging and
assisting’ suicide is a mystery to me.

What will it take, I wonder for the authorities - including the Home Secretary, the
police and the Crown Prosecution Service - to do something about it?

I hope it is not the first barbiturate or nitrogen suicide
of someone in the UK making use of his information and equipment. But I am not holding my breath.

Friday, 28 June 2013

Britain is planning to become the
first country in the world to offer controversial ‘three-parent’ fertility
treatments to families who want to avoid passing on mitochondrial diseases to
their children.The BBC reports this morning on
the new techniques which it is claimed will children born through 'three-person
IVF' who would carry genetic material from each of three different people.

There are about 50 known mitochondrial
diseases (MCDs), which are passed on in genes coded by
mitochondrial (as opposed to nuclear) DNA. They range hugely in severity, but
for most there is presently no cure and little other than supportive treatment.

It is therefore understandable that scientists and affected families want
research into these two related ‘three-parent embryo’ techniques (pronuclear
transfer and maternal spindle transfer) to go ahead. But there are good reasons
for caution.

This is not about finding a cure. It is about preventing people with MCD being
born. We need first to be clear that these new technologies, even if they are
eventually shown to work, will do nothing for the thousands of people already
suffering from mitochondrial disease or for those who will be born with it in
the future.

There are also already some alternative solutions available for affected
couples including adoption and egg donation.

But apart from this I’m left with four big questions.

Is it safe? This is far from established. Each technique involves experimental
reproductive cloning techniques and germline genetic engineering, both highly
controversial and potentially very dangerous. Cloning by nuclear transfer has
so far proved ineffective in humans and unsafe in other mammals with a large
number of cloned individuals spontaneously aborting and many others suffering
from physical abnormalities or limited lifespans. Also, any changes, or
unpredicted genetic problems (mutations) will be passed to future generations.
In general, the more manipulation needed, the higher the severity and frequency
of problems in resulting embryos and fetuses.

Will it work? I am sceptical. This technology uses similar ‘nuclear transfer’
techniques to those used in ‘therapeutic cloning’ for embryonic stem cells
(which has thus far failed to deliver) and animal-human cytoplasmic hybrids
(‘cybrids’). The wild claims made about the therapeutic properties of ‘cybrids’
by the biotechnology industry, research scientists, patient interest groups and
science journalists duped parliament into legalising and licensing animal human
hybrid research in 2008. Few now will remember Gordon Brown’s
empty promises in the Guardian on 18 May that year of ‘cybrids’
offering 'a profound opportunity to save and transform millions of lives' and
his commitment to this research as 'an inherently moral endeavour that can save
and improve the lives of thousands and over time millions of people'. That
measure was supported in a heavily whipped vote as part of the Human
Fertilisation and Embryology Bill, now the HFE Act. But ‘cybrids’ are now a
farcical footnote in history. They have not worked and investors have voted
with their feet. Ironically, it was in that same Act of Parliament, that
provision for this new research was also made.

Is it ethical? No, there are huge ethical issues. A large number of human eggs
will be needed for the research, involving ‘harvesting’ that is both risky and
invasive for women donors. How many debt-laden students or desperate infertile
women will be exploited and incentivised by being offered money or free IVF
treatment in return for their eggs? How many thousands of human embryos will be
destroyed? If it ever works, what issues of identity confusion will arise in
children with effectively three biological parents? What does preventing those
with mitochondrial disease being born say about how we value people already
living with the condition? Where will this selection end? Some mitochondrial
diseases are much less serious than others. Once we have judged some affected
babies not worthy of being conceived, where do we draw the line, and who should
draw it?

Is the debate being handled responsibly? No. The research scientists involved
have huge financial and research-based vested interests and getting the
regulatory changes and research grants to continue and extend their work is
dependent on them being able to sell their case to funders, the public and
decision-makers. Hence their desire for attention-grabbing media headlines and
heart rending (but highly extreme and unusual) human interest stories that are
often selective about what facts they present.

It must be tempting for politicians to make promises of ‘miracle cures’ in
years to come which no one may remember. But I suspect it is much more about
media hype than real hope.

This new push is being driven as much by prestige for government, research
grants for scientists and profits for biotechnology company shareholders as
anything else.

Let’s keep a cool head and instead concentrate on finding real treatments and
providing better support for affected individuals and their families rather
than spending limited health resources on unethical, risky and highly uncertain
high tech solutions that will most likely never deliver.

The media is buzzing today with the news that Britain is
planning to become the first country in the world to offer controversial
‘three-parent’ fertility treatments to families who want to avoid passing on mitochondrial
diseases to their children (See BBC, Guardian,
Times
(£), Independent,
Daily
Mail and Telegraph).

The Department of Health announced yesterday that it would
draw up draft guidelines to allow fertility clinics to offer the technique. The
proposed guidelines would be released for public comment later this year, and
Parliament would vote on a final version in 2014.

Scientists are currently
researching two main three-parent IVF techniques. The first, being developed at
Britain's Newcastle University and known as pronuclear transfer (PNT), swaps
DNA between two fertilised human eggs. Another, called maternal spindle
transfer (MST), swaps material between the mother's egg and a donor egg before
fertilisation.

The BBC is heralding it as a ‘ground-breaking technique for preventing
serious genetic disease’ and a ‘bold step for science and society’. Media
reports are full today of reassurances that that mitochondrial DNA only
accounts for 37 out of our 20,000 human genes and that this therefore is a
small step that will be undertaken only under ‘strict safeguards’.

Most people accessing broadcast media will hear heart-rending accounts of affected families and will get the message that those
opposing the move are Luddites and religious fundamentalists on the lunatic
fringe.

But there are actually very good reasons we should not be
going down this route. Here are just twelve for starters:

1. Even were this new technology to work (and there
are huge questions about that) it would help only a very small handful of
families and only a tiny fraction of those with mitochondrial disorders. One in
6,500 babies is born with mitochondrial disorder, about 200 per year in
Britain. But only five to ten of these have conditions serious enough to merit
this intervention. The technology will
not help the other 190 or the 12,000 people in the UK already living with mitochondrial
disease.

2. Babies with serious mitochondrial disease will
still be born as many families are not aware they are even carrying the abnormal
genes until after the birth of at least one affected child. So this will largely be relevant only in preventing the birth of subsequent affected children to these families.

3. There are already alternative routes for these families
to have unaffected children either through adoption or egg donation (although I
personally have serious ethical misgivings about the latter).

4. Both techniques above involve cell nuclear
replacement ‘cloning’ technology which has not yet been shown to work in
humans. Whilst it appears to be effective in lower mammals like mice (see here) use of cloning
techniques in higher mammals has resulted in huge numbers of miscarriages and
the birth of large numbers of abnormal offspring. It took 273 attempts to
produce Dolly the Sheep and she herself was abnormal dying early. There is a
strong possibility that we may simply be trading mitochondrial disease for
other abnormalities if babies are ever born after use of the technique.

5. It is likely that thousands of embryos will need
to be produced and experimented upon in developing these techniques. Many, like
me, who believe that human embryos are worthy of the utmost respect and
protection as early individual human lives will argue that the end of producing
an unaffected baby does not justify these means.

6. Tens of thousands of eggs will be required for
this research. It is virtually certain that donated excess eggs from those
undergoing fertility treatment will not be adequate to meet this demand and
that egg harvesting from paid donors will be necessary leading to exploitation
ofvulnerable women and exposure toat times high-risk egg-harvesting procedures.

7. If successful, this research will cross an
ethical and safety rubicon by allowing human germline genetic therapy for the
first time in human history. The genes from the third parent will be passed on
down the generations and will be impossible to remove from the family.

8. Any babies resulting from this therapy will have
a third genetic parent whose details will not be on the birth certificate. This
raises issues of personal and family identity for children born as a result of the technique
and will inevitably lead to litigation involving parents wanting to assert
maternity rights and children wanting information about all their genetic
parents. Behind these cases will be the hugely emotive issues of custody and
inheritance.

9. Allowing the technique will lead to further
demands for extension in two ways. It will be argued that if we have accepted germ
line therapy for mitochondrial disease then we should also accept it for genetic
disorders transmitted by nuclear DNA and for less serious mitochondrial
disorders. This will lead to pressure to extend the use of these techniques to
other diseases. By backing germ line therapy even in these limited
circumstances the UK is crossing a line that every other country which has
considered the matter has concluded is too dangerous.

10. These techniques do not offer support or
treatment to people affected with mitochondrial disease but rather are aimed at
identifying these individuals at the embryo stage and genetically engineering
them. There is more than an element of eugenic thinking here. Is it right for
us to decide that lives with serious disability are not worth living to the
extent that such people must be prevented being born or genetically altered to
make them acceptable? This is a very dangerous slippery slope indeed.

11. In addition to genuine compassionate concerns about affected families there are very powerful ideological and financial vested interests in this field including research grants for scientists, profits for biotechnology companies and prestige for the British government.

12. Hard cases do not necessarily make good law or policy. I remain deeply suspicious of the way this 'breakthrough' that will potentially help only a tiny number of people with a very limited number of conditions is being foisted on the British public using emotive personal stories by an incredibly well-organised coalition of politicians, biotechnology companies, journalists, research scientists and patient interest groups without full consideration of the concerns like those above which many have expressed. I suspect there are much bigger agendas here that are not yet being fully disclosed. Are we, for example, seeing reproductive cloning and germ line therapy being deliberately smuggled in under the back door under the guise of compassion? The moving boundaries and mission creep we have seen with other IVF-related technologies should sound a huge note of caution for us.

I have
written previously on mitochondrial disease here,
here,
here
and here.
Also see CMF’s official submissions to the HFEA and Nuffield
consultations on this issue and a recent blog post where we argue that these techniques are unsafe,
unnecessary and unethical.

Colin Hart, Campaign Director of the Coalition for Marriage
(C4M), has this week issued a very useful
summary on the current status of the Marriage
(Same Sex Couples) Bill, which is now moving to Report Stage in the House of
Lords.

It outlines the main concerns
with the bill and the way it undermines civil liberties and changes the meaningsof words like ‘husband’ and ‘wife’.

I have reproduced it below:

The Bill has now
completed its Committee Stage. As is usual, there have been no votes during
Committee Stage. The Bill now moves to Report Stage, scheduled to take place on
8 and 10 July, when we expect there will be votes on key amendments.

During Committee
Stage, many Peers have been pressing for a long list of protections for people
who believe in traditional marriage, including:

• Protecting people at
work from being disciplined just because they voice support for traditional
marriage.

• Stopping local authorities using the Public Sector Equality Duty to ban a
church from hiring public facilities just because the church disagrees with
same-sex marriage.

• Protecting foster carers from being blacklisted by social workers just
because they believe marriage is the union of a man and woman.

• Giving couples the option of marrying according to the real definition of
marriage, rather than being forced to marry according to the new genderless
definition.

• Protecting the right of teachers to express support for traditional marriage
without risking their careers.

• Making clear that freedom of speech about marriage should not be restricted
by equality laws.

There have been some
passionate and excellent speeches from Peers who support these protections, including from a number of the country’s top legal experts. A former Lord
Chancellor and two former senior judges lent their voices to the call for civil
liberty safeguards.

The Government has
promised to change the criminal law so that criticism of same-sex marriage
won’t be, of itself, a hate-crime. We welcome that reassurance, but our primary
concern lies with civil, not criminal, law. For example, employment law and
discrimination law – where the problems are most likely to arise – are part of
civil law. Here, the Government has stubbornly refused to give an inch on
safeguarding the freedom of people who believe in traditional marriage.

They even went as far
as saying people who work in the private sector – let alone public sector –
should be fired if they refuse to provide services for a same-sex wedding. As
far as the Government is concerned, there should be no liberty of conscience in
those circumstances.

That shows what we’re
up against, but we have no intention of backing down. We will be working hard
to call for safeguards for people – like you – who support traditional
marriage.

This is important
work, but we haven’t stopped defending the principle of real marriage. We
always said the Government would tie itself in knots trying to redefine
marriage, and here is just one example: in the official Explanatory Notes which
accompany the Bill, the Government says:

The terms “husband”
and “wife” here refer to a person who is married for the purposes of paragraph
1(2)(c) of Schedule 3. This means that “husband” here will include a man or a
woman in a same sex marriage, as well as a man married to a woman. In a similar
way, “wife” will include a woman married to another woman or a man married to a
man. The result is that this section is to be construed as including both male
and female same sex marriage.

In other words, under
this Bill, a woman can be a “husband” and a man can be “wife”. It just shows
that words lose all meaning when politicians meddle with marriage.

Thursday, 27 June 2013

The
20th Century was defined by economic and class-based divisions between
socialists and capitalists. But, with the main political parties now
increasingly embracing free market capitalism, it is culture rather than
economics which has now become the defining political divide. The 21st Century
is characterised by cultural, social and ethical fault lines between liberals
and conservatives.

The
main vehicles of British culture - parliament, the institutions, judiciary,
universities, media, arts and entertainment- are increasingly now populated and
dominated by a liberal elite which embraces an atheist worldview and the ethics
of secular humanism. People who were in their teens and twenties in the 1960s
are now running the country, 150 years after the start of decline of British
Christendom in 1860.

Social
conservative values I see as including sexual purity, marital faithfulness,
family and community loyalty, upholding the sanctity of life, respect for king
and country, accountability, responsibility, integrity, stewardship, simplicity,
sacrificial service, self-control, a strong work ethic and both charitable
provision and legal protection for the most vulnerable.

In
Britain these social conservative values are essentially Christian values –
which have their roots in the Bible and were revived by the 16th century
reformation, by the 17th century puritanism that drove the
Pilgrim fathers and the non-conformist movement, and by the 18th century
evangelical revival under Wesley and Whitefield (and parallel Great
Awakening in America) which led both to the 19th century social
reform catalysed by the likes of Wilberforce and the Clapham sect and also to
the 19th missionary movement, beginning with Carey in 1793,
which profoundly shaped the Christian culture of the British Empire.

Christian
social conservative values are a strange mixture of right and left wing
political concerns – combining traditionally left wing concerns for the poor,
disabled people, ethnic minorities and concerns about developing world trade,
aid and debt with a more traditionally right wing opposition to abortion,
euthanasia, divorce, sexual immorality and substance abuse.

David
Cameron fails to understand this because he understands Christianity primarily
in terms of its influence on Britain’s architecture, language, constitutional
monarchy and parliamentary democracy but without really grasping Christianity’s
fundamental world view and ethics except in very vague terms.

His recent speech on the 400th anniversary
of the KJV illustrates this well – where he talked about ‘responsibility, hard
work, charity, compassion, humility, self-sacrifice, love…pride in working for
the common good and honouring the social obligations we have to one another, to
our families and our communities…’ but tellingly left out any reference to the
sanctity of life, sexual purity, respect for conscience or most importantly any
reference to the mission of Christ or his incarnation, crucifixion,
resurrection, ascension or return in judgement – concepts which by contrast the Queen does actually seem to understand.

Iain
Duncan Smith in his 2006 analysis of ‘Breakdown Britain’ I believe attributed
accurately the decline to the ‘five pathways to poverty’: family breakdown,
educational failure, economic dependence, indebtedness, and addiction which he
calculated costs us £102 billion per annum. He listed 191 policies
aimed at reversing the breakdown, with which I have much sympathy, but I see
the underlying solutions as predominantly spiritual rather than political.

This
is because at a deeper level I see the breakdown of Britain and its five
'drivers' as symptoms of a more general spiritual malaise – a loss of Christian
faith and values – of Christian belief and behaviour. What is missing is the
sense of accountability, responsibility, human dignity and empathy that has its
roots in a Christian world view.

The
problem with Britain is that like a dying rose it has been severed from the
very roots which were responsible for its, now fading, bloom.

Wednesday, 26 June 2013

Colin McGregor (not his real name) is unlikely to forget his
15th birthday.

‘The night I cut my hand, I was celebrating my birthday,’ he
says. ‘I told my friend I was going to burgle a house down the street because I
wanted a television set. He said I should be careful that I didn’t cut myself
smashing a window but I didn’t take proper precautions and came back bleeding. I
was scared about people’s reactions but a bit excited at the same time. But then
when I told my parents they didn’t take it well at all. All hell broke loose.’

‘Anyway this big cut in my hand needed suturing and then got
infected which meant that I was grounded and couldn’t go out with my mates
until it was properly healed. I missed out on a lot of fun having to stay at
home when they were all out having a good time. And it stopped me playing
tennis too.’

Unplanned lacerations are inevitably traumatic for the
individuals concerned but they also have a negative impact on wider society. A
report from Holyrood’s health and sport committee, published last week, calls
for a national strategy to reduce injuries from burglaries.

Controversially, it recommends starting burglary education ‘as
early as possible - pre-school even’ and making free protective leather gloves
widely available to teenagers as young as 13.

Scotland has one of the highest teenage burglary rates in Western
Europe and while teenage burglary levels are lower in Scotland than for Britain
as a whole, Scottish government targets on reducing teenage burglary have yet
to be met.

Dundee has the highest rate of teenage burglaries and those
in the most deprived areas are almost five times more likely to suffer injuries
than those in the least deprived.

While the report took care not to stigmatise teenage burglary,
it highlighted the danger of injury and the cost to the general public. Teenagers
who burgle are less likely to complete their education, more likely to live on
benefits or in poverty and more likely to experience family conflict.

Andrew Houston,
chief executive of Teenagers 1st, a charity which is broadly in favour of the
report’s recommendations, says that injured burglars fall into three groups.

‘Some injuries are
completely accidental and there is an issue with knowledge and information and
access to leather gloves but there is also an issue with doing burglaries when
they are drunk and which they regret afterwards,’ says Houston. ‘The second
group are proactive and want to injure themselves or are ambivalent but
wouldn’t mind if it happened.’

‘Often those are teenagers
who live in poverty and deprivation. They don’t have aspirations and ambitions
and they don’t feel part of anything. A scar following injury while carrying
out a burglary is often seen as something desirable. It gives them an identity.
Then there is a third group where they get injured after being led on by abusive
people.’

‘It has ever been that teenagers will experiment with
burglary,’ says Houston. ‘It is unlikely we will ever be able to stop that
entirely. We then have a choice. If young people are going to burgle is it our
preference to say, “You must not,” or do we talk about it, explain it is not
the best time to do this, support them and help them to protect themselves?’

Note: This report was
adapted from a Sunday
Times report (£). This was not originally about burglary and injuries but another
illegal activity, having sex with someone under sixteen, which runs the risk of
an unplanned pregnancy. The names have
been changed but the same government committee did actually recommend making
free protective condoms available to teenagers as young as 13.

Sunday, 23 June 2013

Last week I wrote
to the Home Secretary Theresa May advising her about the visit of Australian assisted suicide enthusiast
Philip Nitschke (pictured) and urging her to prevent him entering Britain to conduct a
seminar on methods people can use to kill themselves.

Today Nitschke was detained at Gatwick airport, but
eventually let into the country several hours later after having some ‘items’ temporarily confiscated by border police.

Nitschke (aka Dr
Death) is an extremist and self-publicist whose presence
in the UK puts the lives of vulnerable elderly, depressed and disabled people at grave risk.

His workshop in
London on Tuesday under the auspices of ‘EXIT International’ now looks likely
to go ahead and will advise on the sourcing, supply and use of barbiturates,
helium, nitrogen and other means to commit suicide.

In 2001, Nitschke said
that his so-called ‘peaceful pill’ should be ‘available in the supermarket so
that those old enough to understand death could obtain death peacefully at the
time of their choosing’.

Asked who would qualify for access he replied that ‘all
people qualify, not just those with the training, knowledge or resources to
find out how to “give away” their life and someone needs to provide this
knowledge training or resource necessary to anyone who wants it, including the
depressed, the elderly bereaved, (and) the troubled teen’.

A 2010
report demonstrated that coroners were aware of 51 Australians who had died from an
overdose of Nembutal, a lethal barbiturate that Nitschke has promoted since the
late 1990’s as ‘a peaceful way to die’.

Of the 38 cases fully investigated by coroners, only 11
people were known to have suffered chronic physical pain or a terminal illness
before their deaths. Of the 51, 14 were Australians in their 20’s and 30’s.

Journalist Michael Cook put
it to Nitschke in 2011 that ‘nearly two-thirds of the Australians who died
after quaffing Nembutal... were under 60, and quite a few were in their 20s and
30s... [suggesting that] that mental illness or depression, not unbearable
pain, was the reason for the suicide.’

Nitschke responded,
‘There will be some casualties... but this has to be balanced with the growing
pool of older people who feel immense well-being from having access to this
information, [about suicide drugs].’

In the past, Nitschke's workshops have focused on the use of drugs
and gas to commit suicide, with around half the time being used to explain how
Nembutal, a veterinary sedative, can be used to end life.

He has
explained to attendees the best way to administer drugs and gas in order to
bring about death, and has advertised test kits for Nembutal.

Currently he is the subject of an inquiry by the Australian Health Practitioners Agency (AHPA) in connection with a company called 'Max Dog Brewing' which he has set up in order to sell nitrogen cylinders to the public. Its website claims that they can be used for home brewing (nitrogen produces the bubbles in stout) but Nitschke has admitted on Australian national media that they can equally be used to commit suicide.

The Suicide Act, as amended in 2009, states that ‘an act
capable of encouraging or assisting the suicide or an attempted suicide of
another person’ is illegal, ‘whether or not a suicide, or an attempt at
suicide, occurs’; the emphasis is on whether the accused ‘intended to encourage
or assist suicide or an attempt at suicide’.

I believe that what Nitschke has done at previous workshops
falls within the scope of these offences, because the information shared was
capable of encouraging or assisting an attendee to commit suicide and the
workshop was intended to encourage or assist people to commit suicide by
offering them advice about the ‘best way’ of doing it.

Nitschke’s activities present a real and present risk to
vulnerable members of the British public.

With the growing elderly population, failure of the care
system and worsening economic situation a growing number of frail, disabled,
ill and depressed people in Britain will be feeling under even greater pressure
to end their lives, either for fear that they will not cope, or so as to be
less of a burden to relatives.

They deserve better protection from suicide predators like Nitschke than they
are currently getting.

Let’s hope that no vulnerable person is ‘helped’ over the edge by attending his seminar or as a result of the inevitable media hype that will accompany his visit.

Quite why the Home Secretary allowed him into the UK remains a mystery but Britain deserves an explanation.

Thursday, 20 June 2013

The
Republican-controlled US House of Representatives has passed a bill
that would reduce late abortions.

The plan to restrict terminations to the first 20 weeks
after conception was approved by 228 votes to 196, largely along party lines.

The Pain-Capable Unborn Child Protection Act, which was
based on research showing that the unborn child can experience pain by at least
20 weeks gestation, marks the first time that the United States’ Congress have voted
to give affirmative protection to unborn children.

The debate followed polls showing that 64% of the American
public would support legislation prohibiting abortion after 20 weeks (more
detail is in Parliamentary Network for Critical Issues article).

But the bill has no chance of becoming law as Democrats control
the Senate and the White House has threatened a veto.

Most US states allow abortions to when a baby becomes viable
outside the womb, considered to be some 24 weeks.

The Republican leadership pressed ahead with the abortion
bill after the case of Kermit Gosnell, a Philadelphia abortion doctor who was
recently sentenced to life in prison after being convicted of killing three
babies delivered alive.

There has also been a
lot of support for lowering the upper limit amongst UK politicians.

Nearly two thirds of the British public and more than three-quarters of women
support a reduction in the 24-week upper age limit. 76% of the public think
that aborting a baby at six months is cruel. Furthermore a
2007 poll by Marie Stopes International found that two thirds of GPs
wanted a reduction from 24 weeks.

Why has public opinion changed on late abortion? There are five
main reasons: 4D ultrasound, babies surviving below 24 weeks, stories of
babies born alive after abortion, fetal sentience, and European precedent.

We
have all seen Professor Stuart Campbell's high
resolution 4D ultrasound images of babies 'walking’, swallowing,
coughing, hiccupping from 12 weeks gestation and experienced how mothers bond
emotionally to their babies as a result of these scans. We have also seen
photographs of babies alive in the womb at 20 weeks (left).

The public also know about individual high profile cases like Manchester'sMillie
McDonagh, born after a 22-week pregnancy and the world's most premature
baby, Amillia
Taylor, who was born a week younger in the US. Experts may argue about
survival figures and about comparisons between population-based studies like
EPICure and those from top neonatal units but the fact remains that some babies
do actually survive below 24 weeks.

Stories of babies born
alive after failed abortions are also not uncommon. In a 2007 West
Midlands study of 3,189 cases of termination for fetal anomaly, 102 (3.2%)
babies were born alive. This included 65.7% of those between 20 and 24 weeks.
Accounts such as these understandably upset people.

And then there is the question of whether fetuses feel pain. The general public
intuitively concludes that they do when they hear that from 16 weeks babies
will recoil from a noxious stimulus in the womb and that premature babies born
earlier than 24 weeks, if stabbed in the heel with a needle, will withdraw and
cry. The RCOG wheels out its experts to tell us that babies below 24 weeks do
not have the neurological apparatus to sense pain but fail to tell us that this
is a controversial view not shared by other
experts who regard it as being based on an outdated understanding of
physiology.

Which of us, honestly, can imagine telling the mother who feels her baby kick
at 20 weeks that it is not a sentient being?

Finally, Britain is out of touch with most of Europe in this matter. Most
countries in the EU, 16 out of 27, have a gestational limit of 12 weeks or
less. These include Germany, France, Spain, Portugal, Italy, Belgium and
Austria plus most countries in Eastern and Central Europe who once had far more
liberal laws. At 24 weeks Britain is up there with former Soviet States
Lithuania and Latvia.

In 2010 there were 792 disabled babies and 1,936 able-bodied babies aborted in
Britain between 20 and 24 weeks. Every single one of the latter group was
aborted under ground C of the Abortion Act, which in 98% of cases means
protecting the mental health of the mother.

Lowering the abortion limit to 20 weeks for able-bodied babies (as Miller and
many other MPs would support) would give more legal protection to about 2,000
babies a year; just 1% of the total. It would put clear blue water between the
upper abortion limit and the lower threshold of viability and it also would
show that parliament is beginning to listen.

Of course it would also raise the question of whether we should be doing the
same for disabled babies, who can currently be aborted up until the moment of
birth, a question evaluated by a recent parliamentary inquiry which is due to
report soon.

Wednesday, 19 June 2013

Care Not Killing is a
mainstream UK-based alliance of over 40 organisations and thousands of
individuals which campaigns for better care and support for those who are sick,
disabled and dying and against any weakening of the law to allow euthanasia or
assisted suicide. The Alliance works in Parliament and in the
courts and with health professionals, carers, general public and media.

Court of Appeal

From 13-15 May, three of England's top judges heard the
appeals of Nicklinson, Lamb and 'Martin'; Paul Lamb joined the case after the
death of Tony Nicklinson, whose widow Jane remains a party to the case. The Lord Chief
Justice told the appellants that 'we are acutely aware of the desperate
situation in which the appellants find themselves and we are very sympathetic.
But we know, and they surely know, that we cannot decide this case as a matter
of personal sympathy. We have to decide it as a point of law'.

Media interest in the case has allowed many members of the
general public to hear from disability rights campaigners Katherine Araniello, Dr Kevin Fitzpatrick and Dr Colin Harte, who spoke
eloquently about the risks posed to vulnerable people - notably disabled people
- by a change in the law. Media coverage allowed our spokespeople to confront
advocates with the unsettling facts of what legalisation would mean -
summed up by discussion of the Groningen Protocol, which allows disabled babies
in the Netherlands to be euthanised, in a heated Radio Fivelive exchange. It is
crucially important that the dangerous reality of incremental extension not be
allowed to be swept under the carpet, but exposed to public view.

Falconer Bill

On the final day of the Court of Appeal hearing, Lord
Falconer tabled his
'Assisted Dying Bill' in the House of Lords. The first reading received
virtually no press attention, and there is no date yet scheduled for second
reading. The bill is the successor to Lord Joffe's failed attempt in 2006 and
Lord Falconer's own failed previous attempt in 2009, and the Labour Peer is now
seeking to use the findings of his stacked
'commission' to justify a third attempt, despite the continued opposition
of those who would be directly affected by such legislation - doctors and
disabled people - as well as his democratically
elected colleagues in the House of Commons.

The majority of the professional medical bodies have been
strongly opposed to any change in the law which would change the nature of
medicine, and the vast majority of individual medics across the board support
this stance. The Royal College of General Practitioners (RCGP) has announced a
consultation on assisted suicide, having last opened up the issue six years
ago, and while we remain assured that the daily experience of GPs leaves them firmly
opposed to any weakening of the law, we welcome an opportunity for
practitioners to publicly reaffirm their stance. The consultation is restricted
to members of the RCGP, who we would be delighted to hear from and to discuss
the recent developments with.

The British Medical Association (BMA) saw attempts by
advocates for change to press a neutral stance at last year's Annual
Representative Meeting which was decisively
rejected, and while we are glad that emerging end of life issues such as
the Liverpool Care Pathway have been given priority at
this year's ARM, we are pleased that the other important issues for the
practice of medicine are unlikely to be sidelined due to further efforts by a
determined minority so soon after the BMA last upheld its stance.

Liverpool Care Pathway

Lady Neuberger and her panel of experts have concluded oral
evidence sessions, and are now considering the input from these, alongside
written submissions and the findings of parallel inquiries. Care Minister
Norman Lamb has announced that the Neuberger Inquiry will report in July, and
we await its findings, hopeful that these will reflect the recommendations
of our own submission.

Tuesday, 18 June 2013

When two Glasgow midwives won the right to opt out of
supervising abortions last April I suggested
that the General Medical Council (GMC) needed to revise its professional guidance
on the matter which now seemed to be at odds with the law.

At the time Niall Dickson (pictured), the GMC's chief
executive, actually told
the Guardian that the GMC would need to consider the implications of the
judges' decision on its guidance. He is quoted as saying:

‘We will study the outcome of this ruling, which has just
come out, to see if there are any implications for our guidance. We already
have clear guidance which says that doctors should be open with employers and
colleagues so they can practise in accordance with their beliefs without
compromising patient care.’

As I have heard nothing further from the GMC about the
matter, and almost two months have passed, I have today written to Mr Dickson to ask what is happening. My letter
is below:

Dear Mr Dickson,

I’m writing to enquire whether the General Medical Council
intends to revise its guidance on ‘Personal Beliefs and Medical Practice’ in the
light of the recent Glasgow appeal court ruling on participation in abortion
and, if so, what the timescales for the revision are.

You will be aware that two Roman Catholic midwives won a
landmark legal battle in April to avoid taking any part in abortion procedures.

Mary Doogan, 58, and Concepta Wood, 52, had lost a previous
case against NHS Greater Glasgow and Clyde (GGC) when the court ruled that
their human rights had not been violated as they were not directly involved in
terminations.

However appeal judges ruled their right to conscientious
objection means they can refuse to delegate, supervise or support staff
involved in abortions.

The judgment is significant and has relevance also to
doctors (full judgement here).

As you will know the Abortion Act 1967 gives healthcare
professionals the right to conscientiously object to ‘participate’ in abortion
but the scope of the word ‘participate’ has been the matter of some legal
dispute.

But Lady Dorrian, who heard the recent challenge with Lord
Mackay of Drumadoon and Lord McEwan, said: ‘In our view the right of
conscientious objection extends not only to the actual medical or surgical
termination but to the whole process of treatment given for
that purpose.’

She said the conscientious objection in the legislation is
given ‘not because the acts in question were previously, or may have been,
illegal’ but ‘because it is recognised that the process of abortion is felt by
many people to be morally repugnant’.

She added: ‘It is in keeping with the reason for the
exemption that the wide interpretation which we favour should be given to it.
It is consistent with the reasoning which allowed such an objection in the
first place that it should extend to any involvement in the process of
treatment, the object of which is to terminate a pregnancy.’

In the earlier judgement Lady Smith had said that since
the midwives were not covered by the conscience clause as ‘they (were) not
being asked to play any direct role in bringing about terminations of
pregnancy’.

But this has now been overturned.

The GMC
guidance, which interestingly came into force earlier in the very week of the
judgement, is at odds with this ruling. It currently reads:

‘In England, Wales and Scotland the right to refuse
to participate in terminations of pregnancy (other than where the
termination is necessary to save the life of, or prevent grave injury to,
the pregnant woman), is protected by law under section 4(1) of the
Act. This right is limited to refusal to participate in
the procedure(s) itself and not to pre- or post-treatment care,
advice or management, see the Janaway case: Janaway v Salford Area Health
Authority [1989] 1AC 537′

In para 33 of the Judgment the
court makes clear that professional guidelines can be legally wrong and cannot
overrule statute, it says:

‘Great respect should be given to the advice provided
hitherto by the professional bodies, but prior practice does not necessarily
dictate interpretation. Moreover, when the subject of the advice concerns a
matter of law, there is always the possibility that the advice from the professional
body is incorrect’.

Because this Judgment is from a Scottish Court (and Scotland
is a different jurisdiction to England and Wales) it is not strictly binding on
an English Court. However it will nonetheless have significant persuasive force
in England.

The Abortion Act 1967 applies in England, Wales and Scotland
(but not in Northern Ireland) and when Scottish Courts have adjudicated on such
‘cross border’ legislation in the past their decisions have been taken very
seriously in England and Wales and vice versa.

We have been concerned for some time that the GMC was
over-interpreting the law in a grey area in issuing its guidance. But this
latest judgement has clarified the law in a way that now makes that virtually
certain.

Christian Medical Fellowship has over 4,000 doctors and
1,000 medical students as members and the vast majority would have a moral objection
to participation in abortion. Many other doctors share these views and will
want to know where they now stand with the GMC.

As I said above I would most grateful for an indication of
your plans for review of your guidance along with timescales so that I can keep
our members informed about this important development which has practical implications
for many of them.

Monday, 17 June 2013

In this last week both Belgium and the Netherlands have
taken major steps towards euthanasia for children.

A consensus among members of the Belgian Federal Parliament has
reportedly
formed in support of legislation to allow children to choose to undergo
euthanasia in certain dire cases, according to a report in the Belgian daily newspaper
Der Morgen, as translated by the Paris-based news agency Presseurop.

If child euthanasia is legalized in Belgium, the country
would become the first in the developed world to have a law on the books formally
allowing the practice.

Belgium became the second country in the world after the
Netherlands to legalize euthanasia in 2002, but the statute currently extends
only to people 18 or older.

The bill, introduced by the Socialist party last
December, lays out guidelines for doctors to decide on a case-by-case basis
whether or not a child is mature enough to make the decision to end his or her
own life, as well as whether a child's health is grave and hopeless enough to
warrant euthanasia.

‘The idea is to update the law to take better account of
dramatic situations and extremely harrowing cases we must find a response to,’
Socialist party leader Thierry Giet said shortly after the bill was
introduced, according to Agence France-Presse.

‘On both sides of the linguistic border, liberals and
socialists appear to agree on the fact that age should not be regarded as a
decisive criterion in the event of a request for euthanasia,’ Der Morgen wrote last week.

The decision to consider the bill follows months of
testimony by medical experts, doctors, clergy members and others, and it marks
a turning point in the nation's approach to the rights of young people, some of
whom would be able to choose to die if the law were to pass, even while still
being legally barred from driving, marrying, voting or drinking liquor until
they turned 18.

The bill would also likely allow euthanasia for patients
suffering from Alzheimer's and other diseases leading to advanced dementia, who
may otherwise be deemed incompetent to make the decision to die. There were
1,133 cases of euthanasia recorded in Belgium in 2011, accounting for about 1
percent of the country's deaths that year, according to AFP.

Peter Deconinck, president of the Belgian medical ethics
organization Reflectiegroep Biomedische Ethiek, has come out in support
of expanding the practice to minors, as has the head of the intensive
care unit of Fabiola Hospital in Brussels, who testified before a Belgian
Senate committee.

‘We all know that euthanasia is already practiced on
children,’ he told the committee. ‘Yes, active euthanasia.’

A majority of members of the Belgian Parliament are
reportedly ready to pass the child euthanasia bill.

In a separate move the Royal Dutch Medical Association
(KNMG), which represents doctors in the Netherlands, has
said that distress felt by parents can justify euthanasia of a dying
newborn.

The Netherlands has since 2005 not prosecuted doctors who
perform euthanasia on some minors as long as the doctors act in accordance with
a set of medical guidelines dubbed the Groningen Protocol, drafted by Dr Eduard Verhagen in
2004.

Verhagen reported in the New
England Journal of Medicine (NEJM) in 2005 on 22 babies with spina bifida who
were given lethal injections under the protocol over a seven year period.

However, in a new policy document, ‘Medical decisions about
the lives of newborns with severe abnormalities’ (in
Dutch only) the KNMG now explains why it is acceptable, and perhaps
even necessary, to euthanase children.

What is new about this statement is that it says that the
parents’ suffering may be a reason to kill the newborn.

Amongst other conditions, the policy states that a lethal
injection of muscle relaxant is ethically possible when ‘the period of gasping
and dying persists and the inevitable death is prolonged, in spite of good
preparation, and it causes severe suffering for the parents.’

Dr Verhagen, who is also one of the authors of the recent KNMG
report, explained to Volkskrant,
a leading Dutch newspaper, why parental anguish is relevant.

Doctors should spare parents the ‘abomination’ of seeing
their child die in distress, he argues. It is part of good palliative care.

The criteria for euthanasing newborns are as follows (from
page 54 of the report): if the child is suffering, if it cannot express its own
wishes, if death is inevitable and if the dying process is prolonged, then the
child may be euthanased and spare the parents further severe suffering.

Of the 175,000 babies born every year in The
Netherlands, the
KNMG suggests that about 650 might be cases which would be worthy of
euthanasia.

‘These babies, despite very intensive treatment, will
certainly die in the short term. They have a poor prognosis and a very bleak
life perspective. They may not be dependent on intensive care but they face a
life of serious and hopeless suffering. Doctors and parents face the
exceedingly profound question of whether to start or continue treatment or even
whether a good action may actually be a harm, in view of the suffering and
disability that may result from the poor health of the child.’

These disturbing latest developments in the two countries
which were the first to legalise euthanasia in Europe demonstrate graphically
the incremental extension that takes place once the door is opened and the
public conscience begins to change.

The acceptance of two key concepts is what makes this
extension inevitable – first it is accepted that there is such a thing as a
life not worth living and second that the active ending of a person’s life is
justified in order to lessen the suffering of others.

It was these two principles that were
used to justify the killing an infant with limb abnormalities and
congenital blindness (named Knauer) with parental consent by Dr Karl Brandt in neighbouring
Germany in 1939.

This 'test-case' paved the way for the registration of all
children under three years of age with 'serious hereditary diseases'. This
information was then used by a panel of 'experts', including three medical
professors (who never saw the patients), to authorise death by injection or
starvation of some 6,000 children by the end of the Second World War.

The euthanasia programme in Nazi Germany, later headed by the same Karl Brandt, did not begin in
prison camps like Auschwitz and Treblinka. It began far more subtly with doctors in hospitals
and its very first victims were children who were killed on supposedly
compassionate grounds.

It is bitterly ironic that child euthanasia is happening
again seventy years later on the very same grounds in two countries that share
a common border with Germany.

Wednesday, 12 June 2013

At her coronation in 1953 Queen Elizabeth II was
asked by the Archbishop of Canterbury:

‘Will you to
the utmost of your power maintain the Laws of God and the true profession of
the Gospel? Will you to the utmost of your power maintain in the United Kingdom
the Protestant Reformed Religion established by law? Will you maintain and
preserve inviolably the settlement of the Church of England, and the doctrine,
worship, discipline, and government thereof, as by law established in
England?’

She replied, ‘All this I promise to do’.

The Queen is a committed Christian believer who takes
very seriously her duty to maintain ‘the true profession of the Gospel’.
But what about her similar duty to 'maintain the Laws of God'?

The Laws of God about marriage are very clear. Marriage is a lifelong monogamous bond
between one man and one woman as established by creation ordinance (Genesis
2:24) and upheld by Jesus Christ (Matthew 19:5 ) and his Apostles (Ephesians 5:31).

Furthermore it points to the complementarity, permanence and fruitfulness of
Christ’s own relationship with his bride, the church (Ephesians 5:31-2).

The redefinition of marriage which is the basis of the
Marriage (Same Sex Couples) Bill runs directly contrary to this.

It is therefore very difficult to see how the Queen can give
it her Royal Assent without at the same time violating her Coronation Oath.

Lord Mackay, former Lord Advocate and Lord Chancellor, at a recent event hosted by the Theos think
tank, was also asked just this question - whether, in light
of the Church of England’s opposition, signing the Bill might put the Queen in
breach of her Coronation Oath.

Lord Mackay, who opposes same-sex marriage, said that
ministers should ensure any legislation was consistent with the Queen’s
promise. He said:

‘The Queen under our
constitutional arrangements is expected to act in accordance with the advice of
her ministers, given ultimately through the Prime Minister. The idea of the
Coronation Oath was that it would never be in conflict with that advice and
therefore it is the responsibility of the ministers of the Crown to see that
whatever advice they give is consistent with the proper construction of the
Coronation Oath.’

He added: ‘My hope is that a contradiction between what is
advised and what was sworn should never arise.’

But if the Lords pass this bill this exact situation will actually
arise. The Prime Minister will be advising the Queen to do something which almost certainly violates her Coronation Oath in the very year she celebrates the 60th
anniversary of that coronation.

Even if passed by both Houses of Parliament the Marriage
Bill cannot become law
without receiving royal assent. So the Queen does have the power to block the bill,
even if it is a power she has never yet used with any piece of legislation.

The last time a British Monarch withheld royal assent was over 300 years ago in 1708
– when the last Stuart monarch, Anne, withheld her Assent from a bill
‘for the settling of Militia in Scotland’.

However there have been more recent examples of royal assent
being withheld in other European monarchies.

On 2 December 2008 Grand Duke Henri, Luxembourg's monarch
and a Roman Catholic, refused
to sign a euthanasia bill into law.

As a result the Luxembourg parliament stripped him of his
constitutional powers by amending the constitution so that bills would no
longer require his approval before passing into law.

A precedent for Luxembourg's move was set in 1990, when
Belgium's King Badouin found himself unable to approve an abortion law.

With the king's approval, the government made him a commoner
for several days and passed the law, putting him back on the throne after the
legislature had enacted the bill unilaterally.

Were the Queen to refuse to sign the Marriage Bill, it would
provoke a similar constitutional crisis and would place the British Parliament
in the situation of deciding whether to strip her of her constitutional powers
in order to force it through.

Over 2,500 years ago, Queen Esther of Persia, a Jewess, was
encouraged by her uncle Mordecai to risk her life by taking a stand of
conscience in order to protect her own people.

Their conversation, carried out via messengers, is one of
the most famous in the Old Testament:

‘Then (Esther)
instructed him to say to Mordecai, ‘All the king’s officials and the
people of the royal provinces know that for any man or woman who approaches the
king in the inner court without being summoned the king has but one law: that
they be put to death unless the king extends the gold sceptre to them and
spares their lives…

When Esther’s words
were reported to Mordecai, he sent back this
answer: ‘Do not think that because you are in the king’s house you alone of all
the Jews will escape. For if you remain silent at this time, relief and
deliverance for the Jews will arise from another place, but you and your
father’s family will perish. And who knows but that you have come to your royal
position forsuch a time as this?’

Then Esther sent this
reply to Mordecai: ‘Go, gather together all the Jews who are in Susa, and
fast for me. Do not eat or drink for three days, night or day. I and my
attendants will fast as you do. When this is done, I will go to the king, even
though it is against the law. And if I perish, I perish.’ (Esther 4:11-16)

Is this Queen Elizabeth II’s Queen 'Esther moment' I wonder? Was she brought to royal position ‘for such a time as this’?

We must pray earnestly that she is given great courage and
great wisdom.

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Kiwi, Christian and Medical

This blog deals mainly with matters at the interface of Christianity and Medicine. But I do also diverge into other subjects - especially New Zealand, rugby, economics, developing world, politics and topics of general Christian and/or medical interest. The opinions expressed here are mine and may not necessarily reflect the views of my employer or anyone else associated with me.

About Me

I am CEO of Christian Medical Fellowship, a UK-based organisation with 4,500 UK doctors and 1,000 medical students as members. The opinions expressed here however are mine, and may not necessarily reflect the views of CMF or anyone else associated with me.